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Self-administered Specialty Drug Reminder: Hemophilia Drugs

May 3, 2013

In the March Blue Review, we included a reminder that Blue Cross and Blue Shield of New Mexico (BCBSNM) members are required to use their pharmacy benefit for U.S. FDA-approved self-administered specialty drugs (oral, topical and injectable) and obtain these medications through a pharmacy provider that is contracted to provide specialty pharmacy services. Self-administered drugs should not be submitted on professional/ancillary electronic (ANSI 837P) or paper (CMS-1500) claims. In addition, effective July 1, 2013, the following message will be returned on the electronic payment summary or provider claim summary to providers billing for self-administered drugs, including self-administered drugs for hemophilia: “Self-administered drugs submitted by a medical professional provider are not within the member's medical benefits. These charges must be billed and submitted by a pharmacy provider.”

Sample List of Hemophilia Brand Name Drugs*Please note:This list is subject to change from time to time.

Advate

Alphanate

Alphanate/Von Willebrand Factor Complex/Human

Alphanine SD

Bebulin

Bebulin VH

Benefix

Feiba NF

Feiba VH Immuno

Helixate FS

Hemofil M

Humate-P

Koate-DVI

Kogenate FS

Kogenate FS Bio-Set

Monoclate-P

Mononine

Novoseven

Novoseven RT

Profilnine SD

Recombinate

Refacto

Xyntha

*Trademarks mentioned above are the property of their respective owners.

To help you determine the correct path for medication fulfillment and ensure that the correct benefit is applied, please refer to the Specialty Pharmacy Drug List in the Pharmacy Program section of our website.

Note: In accordance with their benefits, members may be required to use a preferred specialty pharmacy. Please call the number on the member’s ID card to verify coverage or for further assistance or clarification on the member’s benefits. For member’s whose benefits require them to use Prime Therapeutics Specialty Pharmacy, you may fax the prescription to 877-828-3939 or call 877-627-MEDS (6337) for additional information. Medication(s) can be delivered to any requested location (e.g., member’s home or physician’s office).

Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions.